NEWS 1 : Doctors and pharmacists disagree on dispensing

KUALA LUMPUR: The Malaysian Medical Association does not think the country is ready for a separation of duties in the prescribing and dispensing of medication. The Malaysian Pharmaceutical Society, however, differs.
MMA president Dr David Quek said the move would lead to a rise in the cost of healthcare as the sick would have to see a doctor first, then get the prescription filled by a pharmacist.

"It would be a must for patients to see the doctor first before buying any medication.

"It should not be the other way round. Pharmacists, unlike doctors, are not trained to deal with illnesses and pathologies. Some pharmacists actually behave like doctors when they are not empowered to do so," he said.

MPS president Datuk Nancy Ho disagreed saying the separation was a good idea because pharmacists were trained to educate the consumer on medicine.
"We are competent and keen to provide quality pharmaceutical care to the consumers. Separation will enable us to do what we do best in the interest of consumers."

She said pharmacists upheld the highest professional aspirations to provide quality pharmaceutical care.

"There is a strong shift towards active participation by consumers and pharmacists in the decision-making process. A benchmarking and standard operating procedures in community pharmacies will improve the public image and perception of pharmacists."

Federation of Malaysia Consumers' Associations president Datuk N. Marimuthu said through the separation, consumers could become more aware of their medical expenses such as consultation fees, medicine prices and also promote rational prescription of medicines, when pharmacists would examine the prescription as well.

On the other hand, there were also teething problems such as accessibility to pharmacies and the lack of pharmacists.

"The Health Ministry has done a pilot project on the separation but we have yet to know of its findings and the ministry's future plans. Once the initial problems have been ironed out, the separation could benefit consumers in the long run."

Elaborating on the current level of 7,000 registered pharmacists in the country, Ho said the ratio of pharmacists to population at 1 to 4,700 people was acceptable

"By September, the first batch of pharmacists who complete their compulsory government service will improve the ratio. About a quarter of them will be serving as community pharmacists. There are 16 institutions of higher learning producing almost 2,000 new pharmacists per year."

The 21/2 hour NSTLive session yesterday attracted 184 online readers who posted 156 questions and comments.


NEWS 2: DISPENSING MEDICINE: Additional cost for patients

By J.L. PHENIX, Ampang, Selangor


I REFER to your report on the separation of duties in the prescribing and dispensing of medication ("Doctors and pharmacists disagree on dispensing" -- NST, June 19). Separating the two duties would mean additional cost for the patient.

First, he will have to pay for consultation with the doctor; then he will have to pay at the pharmacy when he collects his medicine. Getting to the pharmacy might in some cases mean spending money on public transport as well.

Furthermore, it is my experience that pharmacists are not always open when you expect them to be.

My wife's parents live in a small town about 50km north of Ipoh. There are two doctors in town. They are always available; they know everyone in the town and will make house calls even in the small hours of the morning. There is no pharmacy in the town.

Malaysian Pharmaceutical Society president Datuk Nancy Ho is, of course, all for having pharmacists dispensing medicine. But if her suggestion is implemented, my in-laws would have to travel to Ipoh to fill a prescription.

Even in Kuala Lumpur, I have encountered the problem of pharmacies being closed during lunch hour and after 9pm, whereas there are many 24-hour clinics. How would the MPS resolve this problem of unavailable pharmacists?

NEWS 3 : DISPENSING MEDICINE: Get public opinion first

HE debate on the issue of prescribing and dispensing medicines has been going on for decades. There seems to be no solution and, as a member of the public, I do not see one even in the discussion between the Malaysian Pharmaceutical Society and the Malaysian Medical Association ("Doctors and pharmacists disagree on dispensing" -- NST, June 19). The two bodies are clearly at odds as could be seen from the recent NSTLive panel discussion. One of the core issues of this debate is whether the public will benefit from a separation of the functions of prescribing and dispensing medicine.

We will never be able to answer these questions with the current relationship the two bodies have. There has never been a collaborative study to find out what the public really wants. The public has never been consulted, though there was a mention about a pilot study on the separation.

The questions that need to be answered are: who participated in this study and what were the criteria? Who will be the beneficiaries of any future separation of duties?

We need a system that will benefit the rakyat. Merely improving the ratio of doctors to pharmacists addresses a statistical imbalance, but not the geographical distribution of trained professionals or the socio-economic concerns of the beneficiaries (the public).

There are vast gaps in affordability and accessibility to pharmacies between rural and urban areas.

It is easy to emulate the Australian system. But in Australia, the medical and pharmaceutical sectors are highly regulated, whereas in Malaysia, we have a free market system whereby one can open a clinic or pharmacy wherever one pleases.

The first question is, does the public want a change from the present system of obtaining its medication?

NEWS 4: DISPENSING MEDICINE: Proposed ruling will cause more problems to patients

I REFER to the letters from J.L. Phenix of Ampang, Selangor ("Dispensing medicine: Additional cost for patients" -- NST, June 23) and Narinder Pal Singh of Shah Alam ("Get public opinion first" -- NST, June 23 ). I would disagree with any procedure that leaves the dispensing of medicine to pharmacists, with doctors allowed only to diagnose and prescribe medicines.

It is often easy to put in place new regulations and laws without studying the consequences and implications. We should not rush into any action regarding the prescription and dispensing of medicine outside the hospital system.

I live in Seremban, where almost all pharmacies close at 8pm. Some stay open until 10pm, but even then they will operate without the registered pharmacist, because that person would have gone home by 5pm.

Some of the pharmacies do not have registered pharmacists and many of them sell drugs which need no prescription.

I have hypertension and I have bought Co-Diovan (valsartan hydrochlorothiazid) from pharmacies in Kuala Lumpur, Shah Alam, Kajang, Kota Baru, Ipoh and Klang without any questions asked. The pharmacies do not request me to produce any prescription from any doctor or hospital.

Any new system that allows only pharmacists to dispense medicine will be cumbersome and pose difficulties to people living in smaller and more remote towns and villages.

Even in the bigger towns, there would be difficulties for those who fall sick. What happens when one visits a 24-hour clinic or hospital in the middle of the night? Where do we go to get the medicine at that time of the night? Will this proposed ruling also apply to government hospitals, clinics and private hospitals? If not, why not?

What happens if a patient is prescribed a medicine and the pharmacy does not have it?

Are the pharmacists qualified to dispense a generic or an equivalent brand of medicine?

Is the pharmacist qualified and capable of reading the doctor's mind to determine what the diagnosis is and why the doctor prescribed that particular drug?

Then, there is the question of how far a patient must travel in his sick condition to the pharmacy.

I went to Chennai in India in 2007. I was down with a bad bout of diarrhoea and food poisoning. After dragging myself from my hotel to the nearest clinic, I had to travel 5km to the nearest pharmacy to get the medicine.

To compound the issue, medical treatment will become more expensive because most private doctors will have to charge more for their consultation service as they do not earn enough to pay for the rental of their premises and salaries of their nurses when you remove the small margin they earn from dispensing medications as well.

So, who suffers at the end of the day? Yes, you are right, the people will suffer ultimately.

NEWS 5 : PHARMACISTS: Dispensing move will benefit all

REFER to the letters on dispensing medicine from Narinder Pal Singh of Shah Alam ("Get public opinions first") and J.L. Phenix of Ampang, Selangor ("Additional cost for patients" -- NST, June 23).

Narinder is absolutely right in saying that the issue of the separation of functions of doctors and pharmacists in prescribing and dispensing medicine has been discussed for a long time. But this time it is different, because members of the public were involved in the (NST Live Panel) discussion.

As can be seen from the title of the topic, "Consumer Health -- the way forward", the discussion involves consumers and explores areas that will benefit all stakeholders.

As announced by the Health Ministry in March last year, a pilot project to study the separation issue will be conducted. For the time being, the Malaysian Pharmaceutical Society (MPS) has highlighted to the ministry the benefits separation will have on consumers, the government, doctors and pharmacists and on the pharmaceutical industry as a whole. The bottom line is that all parties will benefit, with the public given top priority.

Based on the advance in information technology and healthcare around the world, Malaysia can look forward to new advances to benefit the consumer. Already, the "Pharmacy in England White Paper" passed last year in the United Kingdom signals a change in pharmaceutical services in England. It is implemented to include screening services from community pharmacies and advanced clinical pharmaceutical services within hospitals and primary-care institutions.

Malaysian hospitals are running special clinical pharmaceutical services such as diabetic care units, and we have been acknowledged by the World Health Organisation as a country with one of the most successful primary healthcare programmes. The good news is that both the Malaysian Medical Association and the MPS are meeting to discuss the issue with an open mind because both organisations have the interests of the public at heart.

In respect of J.L. Phenix's concern over the cost of medicines and access to pharmacies, the MPS has conducted "geo-mapping" analysis to evaluate accessibility to pharmacies in major towns. This is to support our suggestion for pilot study projects in zoned areas of selected towns to ensure easy accessibility for consumers.

The MPS is confident that if a separation of functions (of doctors and pharmacists) is implemented, everyone will find ways to ensure that little extra cost and inconvenience is incurred in exchange for pharmaceutical care.